SCSEP Employer and Host Agency Customer Satisfaction Surveys

Senior Community Service Employment Program Performance Measurement System

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0040 can be found here:

Documents and Forms

Document Name Document Type
Form ETA 9124B SCSEP Employer and Host Agency Customer Satisfaction Surveys Form and Instruction
ETA 9124B Host Agency Customer Satisfaction Survey HOST AGENCY Survey ETA-9124B_9 13 10.pdf Form and Instruction
ETA 9124C Employer Customer Satisfaction Survey EMPLOYER Survey ETA-9124C_9 13 10.pdf Form and Instruction
ETA-9124B Host Agency Survey - Customer Satisfaction HOST AGENCY Survey ETA-9124B_9 2 11.doc Form and Instruction

Information Collection (IC) Details

IC Title:	SCSEP Employer and Host Agency Customer Satisfaction Surveys	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation: 20 CFR Part 641 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	ETA 9124B	Host Agency Customer Satisfaction Survey	HOST AGENCY Survey ETA-9124B_9 13 10.pdf	Yes	No	Paper Only
Form and Instruction	ETA 9124C	Employer Customer Satisfaction Survey	EMPLOYER Survey ETA-9124C_9 13 10.pdf	Yes	No	Paper Only
Form and Instruction	ETA-9124B	Host Agency Survey - Customer Satisfaction	HOST AGENCY Survey ETA-9124B_9 2 11.doc	Yes	Yes	Paper Only

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 15,700	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	15,700	15,700
Annual IC Time Burden (Hours)	2,616	2,616
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.